3112 — Disparities in the Treatment of Schizophrenia
Young AS (VA Greater Los Angeles & UCLA), Hsieh Y
(Florida State University College of Medicine), Xu S
(Kaiser Permanente), Menachemi N
(University of Alabama), Rost KM
(Florida State University College of Medicine)
Comparable individuals should receive comparable treatment in health care systems that provide treatment without disparities. In depressive and anxiety disorders, most affected individuals are encountered in primary care, under-treatment is common, and there are substantial disparities by race/ethnicity, gender, age, and education. The treatment of serious, persistent mental illness is less well understood. While outcomes are good with evidence-based care, rates of appropriate treatment are low. It is generally believed that treatment for schizophrenia is provided in mental health specialty settings, however, it is likely that access to mental health clinicians is limited, especially in rural areas. Researchers have studied disparities in the treatment of schizophrenia in a few clinics and health plans, but little is known more broadly. This study evaluated, nationally, the extent to which patients vary in receipt of antipsychotic medication, referrals, and hospitalizations, by age, gender, minority status, insurance, rurality, and national region.
Multivariate logistic regressions in 3359 visits by individuals diagnosed with schizophrenia sampled in the 1999-2007 National Ambulatory Medical Care Surveys and National Hospital Ambulatory Care Medical Surveys.
Primary care clinicians provided 14% of visits, and 62% of these resulted in a prescription for antipsychotic medication. When primary and specialty care were examined together, visits were less likely to result in an antipsychotic medication prescription for middle-aged (OR = 0.66, p = .03) and rural patients (OR = 0.49, p = .04); and more likely to result in antipsychotic medication prescription for non-Hispanic Blacks (OR = 1.66, p < .05). Visits by non-Hispanic Blacks (OR = 3.90, p < .01) were significantly more likely to result in a referral; visits by patients covered by Medicare (OR = 6.97, p < .01) or Medicaid (OR = 4.23, p = .04) were more likely to result in referral; and visits in the western U.S. (OR = 0.34, p = .02) were less likely to result in referral. Visits by non-Hispanic Blacks were more likely to result in hospitalization (OR = 3.64, CI = 1.13-11.79), while visits made by patients with no insurance (OR < .001, p < 0.0001) were significantly less likely to result in hospitalization. A large proportion of observed disparities was related to whether a patient was treated in primary or specialty care.
These findings provide the first national evidence of potential disparities in the treatment of serious, persistent mental illness. Disparities differ substantially from those found in depressive and anxiety disorders, and are pronounced by race/ethnicity and age.
Research is needed that evaluates interventions to ensure consistently appropriate care for people with schizophrenia.